Predicting and Surviving Prolonged Critical Illness After Congenital Heart Surgery

Area of Science:

• Pediatric critical care medicine
• Congenital heart surgery outcomes
• Healthcare quality improvement

Background:

• Prolonged critical illness (PCI) following congenital heart surgery (CHS) significantly impacts patients and healthcare resources.
• Understanding predictors and variations in PCI is crucial for improving outcomes.

Purpose of the Study:

• To define PCI, identify nonmodifiable and potentially preventable predictors of PCI and its mortality.
• To analyze interhospital variation in PCI rates after CHS.

Main Methods:

• Observational analysis of the Pediatric Cardiac Critical Care Consortium clinical registry.
• Stratified analysis of neonates (≤28 days) and nonneonates (29 days to 18 years).
• Multivariable logistic regression to identify predictors of PCI and mortality.

Main Results:

• PCI occurred in 24% of neonates and 8% of nonneonates, with higher mortality than non-PCI patients.
• Identified 10 neonatal and 19 nonneonatal PCI predictors; only 1 mortality predictor was nonmodifiable.
• Approximately 40% of PCI predictors were nonmodifiable, while most mortality predictors were potentially preventable.

Conclusions:

• While some PCI predictors are nonmodifiable, many are preventable, offering targets for intervention.
• Complications and critical care interventions significantly influence PCI mortality.
• Significant interhospital variation in PCI rates suggests opportunities for quality improvement by adopting practices from high-performing centers.